Army MEDEVAC Policy Must Change to Stop Unnecessary Casualties in Afghanistan

24 Oct 2011

To Secretary of Defense Leon Panetta and President Barack Obama:

For the last seven years I have written about the wars in Iraq and Afghanistan. I have covered the US Army, Marines, Air Force and Navy. I’ve also covered the British, Lithuanian, Afghan and Iraqi forces, among others, in places ranging from Iraq to the Philippines and beyond. My most recent embed in Afghanistan was at personal invitation from then-General David Petraeus. It is said that I have spent more time with American combat forces than any writer in US history. I do not know if this is true, but it’s got to be close. I’ve written three books and probably a thousand articles. My work is known worldwide.

On 12 October, I published a dispatch called “Red Air,” detailing policy shortcomings with US Army Dustoff MEDEVAC procedures. The kernel of the matter is that under the Geneva Conventions, when our Army “Dustoff” MEDEVAC helicopters wear red crosses, they are forbidden to be armed. If they do not wear red crosses, they can be armed.

The Taliban and other enemies in Afghanistan regularly fire upon and hit our helicopters. In Afghanistan, a red cross means “Shoot me; I’m defenseless.” We’d have a better chance warding off vampires with crucifixes.

This battlefield reality causes commanders to send Apache attack helicopters as top cover for the Army Dustoff MEDEVAC helicopters. Yet with perpetual shortages of helicopters in Afghanistan, this leads to delays in evacuating terribly wounded troopers. Importantly, US Air Force, Marines, and the British flying in the same areas do not wear red crosses and are armed. Only the US Army, not the Geneva Conventions, is preventing Dustoffs from using machine guns. Meanwhile, we require yet more helicopters to perform top cover, adding to helicopter stresses, causing delays, and pulling the Apaches away from other fights.

When I exposed this travesty in “Red Air,” military HQ in Kabul responded with a statement addressing alleged discrepancies in my work, requesting that I publish their letter. Sadly for them, they must not have realized that I made high-resolution video/audio of a recent MEDEVAC failure. The reply from HQ was anonymous, and so I responded to the ISAF HQ Press Office: “Put a General’s name on this and I’ll publish ASAP.”

If the Army, in particular, believes in the veracity of its position, a high-ranking person should stand behind the assertions and allegations. Otherwise, as one Air Force Pedro pilot with 420 missions in Afghanistan would write to me a few days ago, it’s just “chaff.”

With nobody supporting the statement, let’s forget about the bulk of the orphaned missive and go straight to the salient points:

“Yon’s point that the Army should arm and remove the red cross from its MEDEVAC aircraft fails to acknowledge larger issues. Doing so would place the US outside its commitment to conducting MEDEVACs under the guidelines of the Geneva Conventions and moral norm for how Western nations identify their aircraft dedicated to medical evacuation.”

The so-called “moral norm” has nothing to do with the realities of our decade-long war in Afghanistan. This statement is prima facie asinine and demonstrates a complete break with realities in Afghanistan.

Key point: Army medics do not wear red crosses. They carry rifles. Separately, we have military medical staff in Kabul who are wearing weapons while in the operating rooms. None wear crosses. Down in Kandahar Province, I recently sat alone on guard duty with a medic in an excellent unit known as 4-4 Cav. There were several machine guns in front of him. This inconsistency alone is enough to unravel the Army argument.

Army policy makers are not upholding the Geneva Conventions, but hiding behind them. There is a power struggle within the Army about who controls those helicopters. The red crosses are being used as crucifixes to ward off change.

As mentioned, the US Air Force, Marines, and British all fly without the red crosses, and nothing precludes the US Army–in this helicopter-deprived war–from removing its crosses. In the event that we go to war with a more reasonable country, such as Canada, we can repaint the crosses, though there is no obligation. In Afghanistan, the Marines perform helicopter evacuations with assets available. Guaranteed they will have machine guns. Likewise, Air Force helicopters come in with hot guns. Nothing is stopping the Army but the Army itself, and the internal politics of who controls the Dustoff helicopters. Secondarily, those who sell or control Apache helicopters have a vested interest in keeping Dustoffs unarmed.

Former Secretary of Defense Robert Gates told me personally that he instituted a 60-minute time limit to get wounded troopers from the battlefield to a hospital. It is noteworthy that the military required a directive from Secretary Gates before meeting these standards. One might erroneously assume that the US military would act in the best interest of its own troops without being ordered. This was not the case.

Remember Walter Reed

Major cover-ups are too numerous to track. Earlier in the war, gross negligence at Army medical facilities was revealed by the press, leading to a purge of leadership, including the resignation of Army Secretary Francis J. Harvey.

Many people will remember the cover-ups revolving around Pat Tillman, Jessica Lynch, and Abu Ghraib. We should not expect a more honest Army when it comes to Dustoffs. To admit the mistake now would be to admit the mistake was not corrected for ten years.

On the whole, the military has met Secretary Gates’ MEDEVAC directive with exemplary performance, yet a small number of informed observers can sense hocus pocus with the numbers.

For instance, after an attack requiring medical evacuation, the unit in combat must transmit a “9-line” report to HQ. Only then does the clock start running for the 60-minute directive. If fire departments waited for specific details for every call, their response times would look more impressive, but many people would die.

In combat, actions on the ground can be stressful, causing a delay in the 9-line even though the unit in contact may have immediately radioed that there is a triple amputation. We also have extreme issues with communications at times. I’ve watched people attempt for hours to establish comms with elements just a few miles away. But that’s another story. There should be no need to wait for paperwork to launch distant helicopters when it’s already confirmed that a 9-line is forthcoming. During the attack described herein, to which I was witness, the 9-line went up quickly due to the calm and quick actions of men of 4-4 Cav, and in particular one Lieutenant Jonathan Flores who did an excellent job. Flores transmitted the 9-line in about six minutes. In reality, the helicopters could have been dispatched immediately upon confirmation of the nature of the wounds. Our location was known. Other times, 9-lines can take much longer due to firefights or other distractions, and so the helicopters will sit on the runway “hot cocked” and ready to spin up. The clock is not yet ticking because the 9-line has not arrived.

Golden Seconds

The enemies in Afghanistan often conduct “complex attacks” with multiple, simultaneous raids or ambushes. When the enemy senses they have created Coalition casualties–often easy to observe with IED strikes–they try to predict where our helicopters will land. For years now, they have tried to predict and prepare the landing zones before the attack unfolds.

During the IED ambush in which Chazray Clark was wounded (see Red Air), the enemy could easily have predicted and then positively ascertained our LZ by simple observation. We had arrived under darkness via helicopters, then moved into the village where Chazray triggered the first bomb. The loud explosion would have been audible for miles.

The enemy is courageous, tactically nimble, and skilled at developing and exploiting advantages. They understand our tactics and we understand theirs. After our helicopter insertion and the bomb strike on Chazray, the enemy would be operating in a heightened state of alert.

The Golden Hour is crucial to survival of the seriously wounded. There also are Golden Minutes. The already-bleeding wounded are not the only ones in danger. The casualties provide a golden opportunity for the enemy to shoot down a helicopter and attack the preoccupied ground force. For the incoming helicopters, and ground forces in combat, minutes are crucial. Delay provides opportunity for the enemy to prepare to attack the helicopter, or in the case of Chazray Clark, ground forces waited on an open LZ for close to half an hour believing the helicopter would arrive quickly.

In that area, known as Zhari District, the enemy employs numerous weapons that can take down a helicopter. The powerful 82mm recoilless rifles regularly destroy our heavily armored vehicles. One shot from an 82 and the helicopter is finished. The far-less-powerful RPG will also do the job.

The failure I videotaped occurred in September 2011. The month before, 38 people including a SEAL team died when an RPG downed their helicopter. The investigation led by Brigadier General Jeffrey Colt would conclude, “The shoot down was not the result of a baited ambush, but rather the result of the enemy being at a heightened state of alert…”

In regard to MEDEVAC, the Army contends that top cover from Apache attack helicopters can replace, or are superior to, machine guns on Dustoffs. Veterans of ground combat will scoff at the notion. Furthermore, putting machine guns on Dustoffs does not exclude piling on Apache top cover. But waiting for that top cover can prove lethal to the patients, Dustoff crews, and ground forces in contact.

Apache helicopters and other assets were providing top cover when the shoot down occurred that killed 38 people. The enemy can fire from cover or concealment that an Apache, UAV, AC-130, or jets cannot see or even hit. Even when the enemy is visible to the Apache, there will be endless tactical variants when the pilot cannot possibly react quickly enough to provide preemptive or interruptive covering fire. Other times, the enemy may be too close (or at a bad angle) to the landing helicopter for response from top cover. Dustoffs have landed in towns, cities, or in depressed areas such as valleys where the enemy can fire down or peer-to-peer in such a way that Apache cover can be mitigated or irrelevant. The enemy often comes from holes, such as a karez entrance, or from under foliage where they are invisible even to our superior optics until the moment they use hot weapons. When they fire machineguns or grenades from inside of buildings, they may remain invisible from above even while firing. The helicopter roaring in for a landing will often be in a dueling situation with a hidden enemy wherein the result may bear true the maxim: “There are the quick, and the dead.”

When a helicopter is coming into a hot LZ, the idea of Golden Hours or Golden Minutes as measurement would be like using miles and hours to measure the distance and duration of a cobra strike. The strike will be close with sudden results. A man in the bush would not wear a crucifix to fend off cobras, and he would not use Apache helicopters to defend against the fangs; he would carry a shotgun. The cobra is drawn to the red cross. He knows that if he can stay hidden, he will get at least one strike – probably more – before the Apache can fire.

As the helicopter lands on a hot LZ, it’s literally down to the speed of the trigger fingers, the skills of the fighters, and luck. The enemy often uses PKM machine guns–every wasted second can mean roughly ten enemy bullets from a single machine gun.

“…as [the helicopter] neared the landing zone from the northwest. A previously undetected group of suspected Taliban fired two or three RPGs in rapid succession from the tower of a two story mud-brick building approximately 220 meters south of the CH-47D. The first RPG missed the helicopter, but the second RPG struck one of the blades of the aft rotor assembly and exploded…” The report continues: “The destruction of the CH-47D rotor system from the rocket propelled grenade until the helicopter crash into the creek bed, likely lasted less than 5 seconds.”

And that was it: Mission failure. 38 people dead. Helicopter destroyed.

Neither the AC-130, the surveillance aircraft, the Apaches, or machine guns on the destroyed aircraft were able to prevent the RPG shots. The enemy got off at least two rocket shots, possibly three, and the Apache did not fire until everyone was down in flames. With burning wreckage on the deck, an Apache comes into action. According to the investigation:

“Fire support and surveillance assets immediately shifted focus to the crash site, and one AH-64 Apache helicopter fired 30mm rounds just west of the suspected RPG point of origin to suppress any potential enemy activity in the vicinity of the crash site.”

The idea that crosses and Apaches can protect Dustoffs is a US Army-manufactured fallacy. This policy grinds down our battle tempo and creates a need for more helicopters. Of course, those people who sell helicopters and helicopter parts, or who get to command all those extra forces and assets, will be tempted to proselytize the need for crosses. Purists who only want to win battles will be called heretics.

Combat troops vociferously complain about the delay between the casualty, the 9-line, and wheels-down at the LZ. Meanwhile, the Army haggles over accounting, and advertises 60 minutes as a success. Any minute longer than the minimum required to land and get out is one minute tempting fate with an enemy who moves fast, and in Zhari District the enemy also shoots straight. During one ambush on 4-4 Cav, the enemy took out three armored vehicles in about thirty seconds using recoilless rifles.

While waiting on a Dustoff to pick up Chazray Clark, an officer can be heard on my video asking about the bird, saying it’s been 45 minutes since the first call. A lieutenant next to me said this is the second time this has happened.

In Zhari, the enemy often fires grenades, and after they know the LZ, every minute we waited there was an invitation for grenades to begin falling. In addition to the reality that Chazray was wide awake and dying, and that the enemy could be preparing to attack the helicopter, they were using the time to prepare to attack us as we left the LZ. Later in the morning, I would photograph what was almost certainly an IED position that the enemy did not quite get into place in time. Our EOD and other troops found myriad bombs in the abandoned village. Chazray died at Kandahar Airfield, landing approximately 65 minutes after the attack. Pedros or armed Dustoffs could have had Chazray to the hospital in about 35 minutes, which also would have unlocked the unit from the LZ to wrestle initiative back from the enemy.

The Army’s next fallback will be that arming the Dustoffs reduces their load capacity. This is true. But again, experienced pilots with hundreds of combat missions will say–and I know from being there–that loads are not the problem. Speed and machine guns are the problem.

After the Dustoff picked up Chazray, we headed into the village. It was rigged so fully with bombs that we didn’t get far. There were minor small-arms fights. Though we never made it far from the LZ due to all the bombs, the next afternoon there was another BOOM. An Afghan Soldier tripped another bomb that took off an arm and his head. No helicopter was needed and so he was taken out in a body bag that night when other helicopters picked us up.

The points made by the Army that Geneva Conventions obligations exist for the Army–but not for the Air Force and Marines or British–are so silly that they do not need to be explained, merely exposed. One must wonder if we’ve lost Dustoff helicopters or crewmembers because Golden Minutes were wasted, or when they came under direct fire they were defenseless.

An accurate appraisal of the situation can be obtained by bypassing the Army Generals. Better to anonymously poll the pilots and crews who collectively have flown thousands of evacuation missions in Afghanistan.

The Army has demonstrated a lack of institutional will and common sense. After ten years they have not fixed the problem.

The Secretary of Defense or the President of the United States should intervene. I will provide my unedited video of the MEDEVAC failure to the Pentagon and White House upon request. I prefer to keep the unedited video “in house” due to the graphic nature. I kindly request that this video be safeguarded from release.